Open Access Case study

Carpal Tunnel Syndrome Caused by Anatomic Anomalies Muscles: A Three Cases Report

Mohamed Ali Sbai, Rami Ben Arab, Leila Essid, Amira Gallas, Khaled Khelil, Monia Boussen, Riadh Maalla

Asian Journal of Research in Surgery, Page 1-6

Carpal tunnel syndrome (CTS) is the most frequent peripheral compression neuropathy. Anatomic variations may be encountered during carpal tunnel surgery.1–3 Compression of the median nerve at the wrist is frequently encountered. Carpal tunnel syndrome usually occurs without any obvious extrinsic causes; several cases have however been reported caused by anomalous or hypertrophic muscles. A survey of the literature shows that compression neuropathy of the median nerve has been reported in relation with anomalies affecting three muscles: the first (or second) lumbrical, the palmaris longus and its anatomic variants and the superficial flexor of long fingers. We can suspect the presence of such an anomalous muscle when the compression syndrome concerns a patient who is not within the “usual” age group with symptoms initiated or aggravated by physical exercise.

This report presents three cases of carpal tunnel syndrome caused by anatomic anomalousmuscles diagnosed peroperatively.

Open Access Case study

Occurrence of Cubital Tunnel Syndrome Due to a Synovial Cyst: A Case Report

Rami Ben Arab, Khaled Khelil, Amira Gallas, Leila Essid, Khaled Bchir, Riadh Maalla, Mohamed Ali Sbai

Asian Journal of Research in Surgery, Page 1-5

The cubital tunnel syndrome is a compressive neuropathy of the ulnar nerve around the elbow. It is the most common neurocompression syndrome in the upper limb after carpal tunnel syndrome. Ulnar nerve entrapment is usually located under the thickening of the proximal fascia between two heads of the ulnar flexor of the carpus, or in the arcade of Osborne at the distal part of the epicondylar curve. However, it can also be caused by occupying masses along the course of the nerve.

This report shows a case of cubital tunnel syndrome caused by ulnar entrapment by a medial synovial cyst. Epidemiology, pathogenesis and diagnosis were discussed and literature was reviewed.

Open Access Case study

Gorlin-Goltz Syndrome: A Case Report

Rami Ben Arab, Amira Gallas, Khaled Khelil, Khaled Bchir, Monia Boussen, Mohamed Ali Sbai

Asian Journal of Research in Surgery, Page 1-6

The Gorlin-Goltz syndrome, also known as Nevoid Basal Cell Carcinoma syndrome, is an uncommon autosomal dominant disorder caused by mutations found on chromosome 9.

This syndrome is characterized by multiple basal cell carcinomas, odontogenic keratocysts and various skeletal abnormalities. This case report presents a 63-year-old man diagnosed with Gorlin-Goltz syndrome by clinical, radiographic and histological findings. The basal cell carcinomas were treated with surgical excision for the biggest ones, and cryotherapy for some of the small ones that are located on the face with a good result.

Through this paper we aim to highlight the importance of an early diagnosis of this syndrome, leading to an early preventive treatment of basal cell carcinomas, a regular and prolonged monitoring of patients and their descendants, with a right genetic advice.

Open Access Original Research Article

Comparative Study between Classic Abdominoperineal Resection versus Sphincter Saving Techniques for Treatment of Low Rectal Cancer

Mohamed Salah Abdelhamid, Hisham Ahmed Nafady, Amro Ali Bacheet, Mohamed Hassan Korani, Ahmed Zaky Garib, Mahmoud Ahmed Negida

Asian Journal of Research in Surgery, Page 1-5

Introduction:  Intersphincteric resection of low rectal a surgical technique extending rectal resection into the intersphincteric space. This procedure is performed by a synchronous abdominoperineal approach with mesorectal. excision and excision of the entire or part of the internal sphincter.

Aim of the Work: is to evaluate the oncological and functional outcome of classic abdominoperineal resection (APR) compared to sphincter sparing ( intersphincteric  resection) (ISR) procedures.

Patient: Group A patients (10 patients): who meet the criteria of ISR possibility and candidates for sphincter preserving procedures Group B patients (10 patients): Who didn’t meet the criteria to do ISR, were subjected to APR. The number of the patients in this short research article were small as it is a preliminary study.

Methods: Total ISR involves complete excision of the internal sphincter. The cut line is at the intersphincteric groove. B. Subtotal ISR involves partial excision of the internal sphincter. The cut line is between the dentate line and the intersphincteric groove. C. Modified partial ISR the cut line is below the dentate line on one side of the tumor. On the opposite side of the tumor, the cut line is above the dentate line. D Partial ISR the cut line is at or above the level of the dentate line.

Results: showed that after 6 months, out of 10 patients underwent ISR, 6 patients were highly satisfied with Grade I continence according to Kirwan’s grade. While 4 patients were Grade II, i.e.: Incontinent to flatus. Non significant difference in the rate of recurrence between the two groups.

Conclusion:  In low rectal cancer, the sphincter preservation appears to have nearly the same oncologic outcome compared to APR,. However, patients with sphincter preservation have certainly demonstrated an indisputable better functional outcome, in terms of stoma avoidance and adequate continence.

Open Access Original Research Article

Comparative Analysis of Parathyroid Functions among Sub-total Thyroidectomy Patients after Ligation of Inferior Thryoid Artery

Azhar Iqbal, Noreen Maqbool Bokhari, Mubashir Zafar, Sarfraz Khan Janjua

Asian Journal of Research in Surgery, Page 1-8

Background: Thyroid surgery commonly in developing countries. Hyperparathyroidism is major issue after surgery. The objective of study is to compare the occurrence of hyperparathyroidism after sub-total thyroidectomy with truncal ligation versus non-ligation of inferior thyroid artery.

Methods: Study design was randomized clinical trial. Study was conducted in public sector hospital. Surgical patients who were admitted to hospital for thyroid surgery. Participants were divided into two groups through random allocation, thyroid surgery with and without the ligation of inferior thyroid artery Thyroid surgery for group A with ligation and group B without ligation of inferior thyroid artery.  Serum PTH levels were measured on 3rd post-operative day. The group A and B were compared for level of for the frequency of transient hyperparathyroidism.

Results: Mean age in group A was 40.83 yrs (SD = 9.9) and in group B it was 41.34 yrs (SD=8.73). Transient hyperparathyroidism was observed in 6.10% of patients in group A and 7.32% patients in group B and this difference was found to be statistically significant (p=0.02).

Conclusion: Result showed that ligation of artery decreased the risk of transient hyperparathyroidism after sub-total thyroidectomy.